Provider Demographics
NPI:1932199965
Name:GRIFFITHS, GLENN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:CHARLES
Last Name:GRIFFITHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 FRANKFORT HWY
Mailing Address - Street 2:
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616-8632
Mailing Address - Country:US
Mailing Address - Phone:231-882-9661
Mailing Address - Fax:
Practice Address - Street 1:8225 LAKE ST
Practice Address - Street 2:
Practice Address - City:BEAR LAKE
Practice Address - State:MI
Practice Address - Zip Code:49614-9612
Practice Address - Country:US
Practice Address - Phone:231-864-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39606207Q00000X
MI4301091466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine